Clinical management of patients across cultures challenges the clinician's familiar tried and tested strategies. The relationship between the patient and the psychiatrist is often examined in isolation from a number of premises that both patient and professional bring to the encounter: previous experience of other cultures, contact with less familiar cultures, past experiences and socioeconomic status are some of the determinant influences. There are a number of ways in which the clinician can facilitate therapeutic effectiveness. However, a trusting relationship must first emerge such that the patient has faith in the treatment recommendations. Special difficulties can arise in the context of pharmacological, social, psychotherapeutic and psychological interventions. Community, out-patient, in-patient and emergency settings each require that consideration be given to the context of the assessment and treatment process, as well as the content and immediate outcome. The clinician must plan the assessment and intervention carefully. The rationale and goals of treatment should be discussed and agreed by participants in the therapeutic interaction. Special groups face unique cultural and historical obstacles to receiving healthcare. Basic principles are described in this chapter: psychopharmacology is discussed in greater detail in Chapter 21 and psychotherapy in Chapter 26.

Psychiatry across cultures

Britain is undeniably a multicultural society. The needs of patients from other cultures are becoming paramount in the planning and delivery of psychiatric services. In the preceding chapter we highlighted some of the problems that psychiatrists may come across in the process of assessment; here we will focus on the clinical management of patients from other cultures.